Dr Lakshmi Narasimhan, who leads research at The Banyan Academy, has worked with women since 2005 and focuses on homelessness, poverty, and mental health. Her work spans inpatient care, livelihoods, and housing, engaging people where they are and supporting them to live on their own terms.
She notes that mental health care in India often remains limited to treatment and containment, missing the broader context of people’s lives. “People live in social and cultural worlds, and there are so many ways in which that affects how they progress on this journey of living with a mental health condition,” she says.
For Lakshmi, the challenge lies in moving beyond binary frameworks of illness and recovery to ensure sustained dignity and quality of life. “What is possible,” she adds, “is ensuring good quality of life, ensuring supports, ensuring that somebody is there for you no matter what, for a lifetime.”
00:00I think in mental health, one of the biggest challenges, at least as I see it, is that it's become too binary in terms of if you develop a condition, if you get them on to treatment very early in terms of biomedicine, the life will be set. And it's not as straightforward. Psychiatry is very young. And I don't think we have predictable outcomes as yet. But what is possible is good quality of life.
00:23So the Banyan is an organization that has been working for the last 30 plus years with the population of people who face homelessness and poverty along with mental health conditions and our work essentially across the different interventions that we offer, whether it is residential care, inpatient services or whether it's livelihoods or housing in the community.
00:51Whatever shape and form it takes is essentially about engaging with people where they are and looking at supporting them so that they are able to live the kind of lives that they want to live.
01:02So in terms of creating and enabling pathways for them, looking at quality of life, looking at dignity affirming care more than anything else, irrespective of where they may be on clinical terms.
01:17So that's the essence, I would think, in terms of the Banyan's work.
01:23If you look at the landscape of mental health care, whether it's globally or in India, of course, one can highlight different sorts of things one can talk about.
01:34But the reality of mental health care as it stands today is that one needs to understand that when you have a mental health condition and the way your life unfolds in this journey need not look the same for everybody.
01:52And it need not look necessarily like symptom reduction for everybody.
01:56It need not look like going to work in the typical ways for everybody.
02:01And that's the reality of it.
02:02So when you look at the sort of services that are available in India, predominantly for a low income population now, somehow because of the sort of investments that we've been able to make, whether it's the government or in terms of civil society initiatives, they center around this paradigm of containment.
02:21So you look at people living in certain spaces and or it goes into a paradigm of getting them into treatment very early and giving them medication.
02:31But what we have found in the Banyan, who are the people who come to us?
02:34There are people who come to us.
02:36They've gone to different treatment facilities, right, but they still end up homeless.
02:39So they've navigated all these different pathways and they've still ended up homeless.
02:43They've still come to the Banyan.
02:44So that's the reality of mental health care as it stands today in India.
02:48And the missing piece really is that one is too caught up in terms of let's get this person, the person with mental illness, let's get this person very early on into treatment and medication.
02:59That itself doesn't solve the issue.
03:01People live in social and cultural worlds.
03:03And there are so many ways in which that affects how they progress in this journey of living with a mental health condition.
03:12So if I'm a woman and let's say I'm living in a house where I do all of the household chores, I take care of my children.
03:22I'm also responsible for earning for the household.
03:24So, you know, we have clients who every day get up early in the morning, get vegetables in the market, go out in the evening.
03:32We have clients who, you know, engage in small businesses of their own, take mopeds to seven, eight villages in the vicinity and sell it, earn money for their family.
03:42I do all of this.
03:43But what sticks in my social circle, especially when it comes to my immediate family sometimes, is the episode that I had after I gave birth.
03:51Right.
03:52And they still see me as a person with a mental illness and they still treat me that way.
03:57Despite all of these other labors that I perform and the way that I stand up for my family.
04:04So it doesn't matter if this person has gone access to clinic, has been in an inpatient center.
04:11So many of our women come from circumstances like this because look at the world that they are living in.
04:17So I think in mental health, one of the biggest challenges, at least as I see it, is that it's become too binary in terms of if you develop a condition, if you get them onto treatment very early in terms of biomedicine, the life will be set.
04:30And it's not as straightforward.
04:32Psychiatry is very young and I don't think we have predictable outcomes as yet.
04:37But what is possible is good quality of life, ensuring good quality of life, ensuring supports, ensuring that somebody is there for you no matter what for a lifetime in terms of all the ups and downs that one may go through can be assured.
04:53So one layer of substantive freedoms is, I would say, so it's ideal to say that we will remove systemic oppression.
05:01But what is possible is to build this person's internal resources and to make sure that there is a baseline level of dignity in terms of material conditions that they live in, right?
05:14So look at their material conditions, also consider in terms of building their internal resources.
05:20So one of the peer advocates that I was in conversation today, actually, they made a very powerful statement.
05:28What she said is that the minute you find your voice to speak for yourself and stand up, you will see shifts in the community, not immediately and even in the family, not immediately, but over a period of time.
05:44So maybe they look at me in certain ways today.
05:48But when I have stood for myself, when I have showed up for work, when I've showed up for my child, when I've showed up for myself in every way that I want to every day.
05:59And that's because and that strength also comes from within.
06:02Then I see that, yes, you know, they may start consulting me for small things.
06:06The community may invite me for events.
06:08So she spoke of stigma as not something that is static at one point of time and it will keep fluctuating.
06:13But you need to be able to stand for yourself and be as difficult as it may be to draw from that inner strength.
06:21So I think one level of stigma is in terms of just building your own visibility and occupying the space that you know you're entitled to in society.
06:30So I think that's one aspect of stigma.
06:33And of course, the long term pipeline dream is to completely remove the different oppressions that we see.
06:41That can we can we look at a world that perhaps is kinder and has more opportunities for everybody, irrespective of circumstances they come with.
06:52So how do we remove disparities more substantively?
06:55But that's a far away pipeline dream.
07:00And yeah, so those are the two ways.
07:02Yeah.
07:03So I think this this is a very interesting experience because and I'm also perhaps talking here more from a research point of view,
07:12because when we go and we engage with stories and we gather them and then we sort of, you know, look at it together as a team and what does the story say and engage in the dialogue, it works a bit differently.
07:25What what I really enjoyed with the stories that came through and some of the stories, I also know the people who are featured there.
07:33So I can, when I'm reading the stories, I can, you know, visualize them and listen and hear them in my head, at least.
07:40So that was very interesting for me because it was written in a language that is perhaps I wouldn't say simple, but I would say a language that feels like somebody is reading the story to you and you're in the center of those stories.
07:55So that was very interesting for me because it kept it in people's own words to the last, you know, some of the stories, especially the one that is on caste and mental health, for instance, or the other story,
08:10which perhaps looks at a very complex phenomena of mass suicide and a family engaged in it, but talks about the many other things that one typically doesn't look at when, you know, you see newspaper coverage on a phenomena like this.
08:26So it was interesting for me to actually hear the stories as they are.
08:31And it's a journey. So I feel like we need to embrace messiness and honest mistakes.
08:37So perhaps because we've all been in mental health sector for a very long time, we've engaged with people with mental health conditions.
08:44Some of us ourselves live with mental health conditions.
08:47So we perceive the language, the vocabulary in a certain way.
08:50We perceive representation in a certain way.
08:53That may not be the case for people from other professions.
08:56I would also see people from other professions who perhaps are also mental health service users themselves.
09:01But one needs to embrace the messiness of it and the honest mistakes.
09:05And what was very nice for me personally is this conversation that we kept having in terms of how does one, you know, frame this?
09:13How do you want to look at this story?
09:15Is there something that we need to be sensitive about?
09:17So I got to speak to quite a few journalists in terms of how do they frame the story?
09:21How do they approach?
09:22What would be a good way to also start the conversation with certain people?
09:27I think one of the biggest takeaways from an issue like this that's focused on mental health and that too in the context of freedom is because mental health is actually at the core a justice issue.
09:42It's not so much, it's not just to do with health.
09:45It is largely to do with the social.
09:48Yes, it is health.
09:49Yes, it is social.
09:50But it's also about justice.
09:52And I think when magazines, which a wide variety of people read from and they come with their own experiences and they engage with such content, it does foster a certain different kind of a dialogue rather than, let's say, an academic journal doing it.
10:09Or even if it was just pieces that, you know, people do documentaries, people do small social media pieces, they generate conversations of a different kind than the sort of format where we're looking at, where we can get to stories in depth, you know, in this kind of a written format.
10:24So I think it's significant because I feel like it brings it to center stage.
10:30It gives the opportunity to talk to a very diverse audience about mental health, not just in a very siloed treatment, that sort of a thing.
10:41But in terms of the so many different layers that one needs to feel.
10:47Yes, yes.
10:49And feeling also, feeling perhaps not sometimes alone.
10:53I would also say that even for people who are working in the sector itself, it's nice to see the large variety of stories that come up.
11:02One of the stories that was interesting for me to review and give feedback and work with the Outlook team was the story that was done in terms of caste and mental health, looking at the Dome community that engages in a specific profession.
11:19And why it was also interesting is because this is a story that needs to be told from the lens of how systemic oppression leads to people being in certain circumstances and what sort of mental health effects are there.
11:35Not in terms of pathologizing their, you know, their mental health conditions.
11:41I think the great thing about Outlook focusing on mental health in the specific issue is when one talks about mental health conditions in general, in a lot of ways, one could, of course, look at it as a disease.
11:54But it's in a lot of ways, but it's in a lot of ways also people who resist social oppression, who break away from norms and build their own ways of living in some sense.
12:05I think the great thing about a dedicated issue on mental health and freedom, especially where we stand today in the world in terms of what the mental health landscape looks like is that people are able to tell their stories and it finds a voice in so many pages that many people across the length and breadth of India are going to read.
12:28And it takes stories to the drawing rooms of so many families, people will start having conversations and it's told from the perspective of somebody who has faced mental health conditions from extremely oppressed circumstances, be it caste, be it gender, be it whatever it may be.
12:47And I think that's the great thing about this issue.
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